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A thymectomy, which can be either partial or total, is a surgical procedure that involves the removal of the thymus gland, an organ located in the upper chest beneath the sternum. This gland plays a crucial role in the immune system, particularly during fetal development and childhood, as it is responsible for the production and maturation of T-lymphocytes, a type of white blood cell essential for immune response. The thymus reaches its peak size during puberty and subsequently diminishes, being replaced by fatty tissue in adulthood. The procedure is typically performed using either a sternal split or a transthoracic approach, which allows for direct access to the thymus. Thymectomy is indicated for various conditions, including non-metastatic thymoma, thymic carcinoid, thymic carcinoma, and myasthenia gravis. The surgical approach may involve radical mediastinal dissection, which entails the removal of not only the thymus but also surrounding mediastinal structures if metastatic lesions are present. This procedure is classified as a separate procedure, highlighting its complexity and the need for careful surgical technique to ensure thorough removal of the thymus and any associated pathological tissues.
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The thymectomy procedure is indicated for the following conditions:
The thymectomy procedure involves several detailed steps to ensure the complete removal of the thymus gland and any associated tissues. The surgical approach begins with a sternal split, where an incision is made over the sternum. The skin is carefully incised, and the manubrium, the upper part of the sternum, is exposed and completely divided. The sternal split is then extended down to the third or fourth intercostal space, allowing for adequate access to the thoracic cavity. Once the sternum is retracted, both pleural spaces are opened, and the phrenic nerves, which are crucial for diaphragm function, are identified to avoid injury during the procedure.
Next, the overlying mediastinal pleura is divided, exposing the anterior thymus and the innominate vein. The thymus, along with the fat that covers the pericardium, is mobilized starting from the right inferior horn. After the lower horn is completely freed from the pericardium, the right superior horn is similarly mobilized. The thyrothymic ligament is then exposed, and the right superior horn is divided from the thyroid gland, followed by ligation of the thyrothymic ligament. The thymus is retracted toward the left side, and the lateral arterial blood supply from the internal mammary artery is isolated, ligated, and divided. The left lower and upper horns of the thymus are freed in the same manner as the right side.
After mobilizing all four horns of the thymus, the innominate vein is clamped, divided, and ligated with sutures. The thymus is then removed from the thoracic cavity. If a thymic mass is present, frozen sections are taken and sent to pathology for evaluation. The surgeon inspects adjacent anatomical structures for any possible metastatic lesions. If such lesions are identified, the involved structures are removed along with the thymus to ensure complete excision of malignant tissues. Following the removal, a chest tube is placed to facilitate drainage, the sternum is closed using wire sutures, and the soft tissue and skin are closed with absorbable stitches to promote healing.
Post-procedure care involves monitoring the patient for any complications related to the surgery, such as bleeding or infection. The placement of a chest tube aids in the management of any fluid accumulation in the thoracic cavity, and its removal will depend on the patient's recovery and the absence of complications. Patients can expect a recovery period that may vary based on individual health factors and the extent of the surgery performed. Follow-up appointments are essential to assess healing and to review pathology results if frozen sections were taken during the procedure. Additionally, patients may require further treatment or monitoring depending on the underlying condition that necessitated the thymectomy.
| Short Descr | REMOVAL OF THYMUS GLAND | Medium Descr | THYMECTOMY PRTL/TOT RAD MEDSTNL DSJ SPX | Long Descr | Thymectomy, partial or total; sternal split or transthoracic approach, with radical mediastinal dissection (separate procedure) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 12 - Other therapeutic endocrine procedures |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 1995-01-01 | Added | First appearance in code book in 1995. |
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